The treatment of anemia in chronic kidney disease (CKD) patients just prior to requiring renal replacement therapy (RRT) is suboptimal. In addition to early referral to a nephrologist for patients with CKD, early referral to a dedicated clinic such as the anemia clinic (AC) may improve anemia management prior to the initiation of RRT and overall survival of the patient while receiving RRT. The objective of this retrospective study was to evaluate the achieved hemoglobin (Hgb) and hematocrit (Hct) levels for patients enrolled in the AC who subsequently progressed to end-stage renal disease (ESRD) and required RRT. Of 141 patients referred to the AC for anemia management, 38 patients progressed to ESRD during the initial 15 months the clinic was open. Of these 38 patients, only 15 had been seen in the AC 6 or more times (approximately once a month) while ongoing erythropoietin analog therapy. The average length of therapy was nearly 9 months (35.7 ± 13.9 weeks). These patients were prevalently African American (73%) females (80%). The average age was 57.2 ± 15.6 years old and the average CrCl at the time of enrollment into the AC was 12.4 ± 4.5 mL/min. Initial Hgb and Hct levels were 8.6 ± 3.1 g/dL and 25.9 ± 9.2%, respectively. During the period of anemia management while enrolled in the AC, the average Hgb and Hct levels increased to 10.9 ± 0.2 g/dL (p < .0003) and 32.8 ± 0.5% (p < .0002), respectively. Hgb and Hct levels for those intitially naive to analog therapy were even higher at 11.1 ± 0.1 g/dL and 33.7 ± 0.5%. Analysis of discrete values right before initiation of RRT demonstrated that 13% had hematocrits < 28% and 33% had hematocrits < 30%. Of note, a significant number (27%) of the initial 38 patients who were erythropoietin analog naïve, although not included in the above analysis, required RRT 1 month after being referred to the AC. Many patients with CKD and anemia are not treated early enough. Despite late referral, a dedicated AC can still improve the Hgb and Hct of patients who are close to initiating RRT for ESRD.
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